MEDICARE: WAYNE LEROY RILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2065X	Child Physical Disabilities Respite Care		ND

General Provider Information

NPI Number	:	1043190812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE LEROY RILEY

Provider Business Mailing Address
First Line	:	1628 LEWIS BLVD
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58203-1639
Country	:	US
Telephone Number	:	701-740-0470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1628 LEWIS BLVD
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58203-1639
Country	:	US
Telephone Number	:	701-740-0470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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Directions to “ WAYNE LEROY RILEY ” Practice Location

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